Author + information
- Gilbert Tang1,
- Mohammad Khan2,
- Syed Zaid3,
- Tanya Dutta2,
- Mala Sharma2,
- Angelica Poniros2,
- Hasan Ahmad4,
- Ryan Kaple2,
- Martin Cohen2 and
- Steven Lansman3
- 1Mount Sinai Health System, New York, New York, United States
- 2Westchester Medical Center, Valhalla, New York, United States
- 3Westchester Medical Center/New York Medical College, Valhalla, New York, United States
- 4Westchester Medical Center/New York Medical College, White Plains, New York, United States
Patients undergoing TAVR often have concomitant severe mitral regurgitation that does not improve and not all are anatomical candidates for Mitraclip repair. Transcatheter mitral valve replacement (TMVR) is a promising alternative, but has potential risk of left ventricular outflow tract (LVOT) obstruction. Aortomitral annular angle (AMAA) is a known predictor of LVOT obstruction after TMVR, with increased risk associated with AMAA <120°. We aim to determine the effect of TAVR on the risk of LVOT obstruction if same patients were to undergo TMVR.
Pre- and Post- TAVR AMAA were measured from a standard parasternal long-axis view in mid-systole on transthoracic echocardiography in 128 consecutive patients with symptomatic severe aortic stenosis, who underwent TAVR with the Edwards Sapien valve (ES), Sapien XT (XT) valve or Medtronic CoreValve (CV) between 2/2013 and 7/2016. All measurements were performed and reviewed by expert echocardiographers. Mean AMAA values pre- and post-TAVR using 3 separate measurements for each angle were obtained and compared using paired sample T-Test.
There were no differences in baseline pre-TAVR AMAA among the ES, XT, CV groups. Overall pre-TAVR AMAA increased from 128.0±15.9° to 130.6±16.5° across groups with TAVR, a mean increase of 2.6° (2.0%, p=0.003). With ES TAVR, AMAA increased from 124.5±11.8° to 128.8.2±13.4°, a mean increase of 4.31° (3.5%, P=0.016) while no differences were found in XT group (134.3±8.6° to 134.8±8.9°, p=0.60). In MC TAVR, AMAA increased from 127.0±11.0° to 130.5 ±12.6°, a mean increase of 3.51° (2.8%, P=0.07). Among 18 (44%) ES patients whose pre-TAVR AMAA was <120°, AMAA increased to >120° in 44% afterwards. Among 12 (29%) MCV patients who had pre-TAVR AMAA <120°, 50% had AMAA increased to >120° afterwards.
AMAA significantly increased after TAVR with Sapien but not XT or Medtronic CoreValve. In patients with Sapien valve, the increase in AMAA may predict a lower likelihood of LVOT obstruction if the same patients were to undergo TMVR. Further studies are required to confirm and determine the mechanism and significance of these results.
STRUCTURAL: Valvular Disease: Aortic